Surgical treatment of four segment lumbar spondylolysis: A case report

paythelady.612 shared this article with you from Inoreader Surgical treatment of four segment lumbar spondylolysis: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 16;9(17):4408-4414. doi: 10.12998/wjcc.v9.i17.4408. ABSTRACT BACKGROUND: Four-level lumbar spondylolysis is extremely rare. So far, only 1 case has been reported in the literature. CASE SUMMARY: A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years. Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5. Lumbar magnetic resonance imaging showed normal signal in all lumbar discs. Because daily activities were severely limited, surgery was recommended for the case. The patient underwent four-level bilateral isthmic repair at L2-L5. During surgery, L2-L5 isthmi were curetted bilaterally, freshened, and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod. The symptoms of back pain almost disappeared . He has been followed-up for 96 mo, and his symptoms have never recurred. Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan. CONCLUSION: We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair. PMID:34141808 | PMC:PMC8173437 | DOI:10.12998/wjcc.v9.i17.4408 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Arrhythmogenic right ventricular cardiomyopathy characterized by recurrent syncope during exercise: A case report

paythelady.612 shared this article with you from Inoreader Arrhythmogenic right ventricular cardiomyopathy characterized by recurrent syncope during exercise: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 6;9(16):4095-4103. doi: 10.12998/wjcc.v9.i16.4095. ABSTRACT BACKGROUND: Arrhythmogenic right ventricular (RV) cardiomyopathy is a rare and currently underrecognized cardiomyopathy characterized by the replacement of RV myocardium by fibrofatty tissue. It may be asymptomatic or symptomatic (palpitations or syncope) and may induce sudden cardiac death, especially during exercise. To prevent adverse events such as sudden cardiac death and heart failure, early diagnosis and treatment of arrhythmogenic RV cardiomyopathy (ARVC) are crucial. We report a patient with ARVC characterized by recurrent syncope during exercise who was successfully treated with combined endocardial and epicardial catheter ablation. CASE SUMMARY: A 43-year-old man was referred for an episode of syncope during exercise. Previously, the patient experienced two episodes of syncope without a firm etiological diagnosis. An electrocardiog ram obtained at admission indicated ventricular tachycardia originating from the inferior wall of the right ventricle. The ventricular tachycardia was terminated with intravenous propafenone. A repeat electrocardiogram showed a regular sinus rhythm with negative T waves and a delayed S-wave upstroke from leads V1 to V4. Cardiac magnetic resonance imaging showed RV free wall thinning, regional RV akinesia, RV dilatation and fibrofatty infiltration (RV ejection fraction of 38%). An electrophysiological study showed multiple inducible ventricular tachycardia as of a focal mechanism from the right ventricle. Endocardial and epicardial voltage mapping demonstrated scar tissue in the anterior wall, free wall and posterior wall of the right ventricle. Late potentials were also recorded. The patient was diagnosed with ARVC and treated with combined endocardial and epicardial catheter ablation with a very satisfactory follow-up result. CONCLUSION: Clinicians should be aware of ARVC, an d further workup, including imaging with multiple modalities, should be pursued. The combination of epicardial and endocardial catheter ablation can lead to a good outcome. PMID:34141771 | PMC:PMC8180221 | DOI:10.12998/wjcc.v9.i16.4095 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of artificial liver support system in severe immune-associated hepatitis caused by camrelizumab: A case report and review of the literature

paythelady.612 shared this article with you from Inoreader Efficacy of artificial liver support system in severe immune-associated hepatitis caused by camrelizumab: A case report and review of the literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 16;9(17):4415-4422. doi: 10.12998/wjcc.v9.i17.4415. ABSTRACT BACKGROUND: Immune checkpoint inhibitors (ICIs) can lead to immune-related hepatitis (IRH) and severe liver damage, which is life-threatening in the absence of specific treatment. CASE SUMMARY: A 75-year-old man was admitted to our hospital complaining of loss of appetite, yellow urine, and abnormal liver function for the past 2 wk. Three months prior to admission, he was treated with two rounds of capecitabine in combination with camrelizumab for lymph node metastasis of esophageal cancer. Although liver function was normal before treatment, abnormal liver function appeared at week 5. Capecitabine and camrelizumab were discontinued. Ursodeoxycholic acid and methylprednisolone 40 mg daily were administered. Liver function continued to deteriorate. Prothrombin time and international normalized ratio were 19 s and 1.8, respectively. The patien t was diagnosed with acute liver failure. A pathological analysis of liver biopsy indicated a strongly positive immunohistochemical staining of T8+ cells, thereby suggesting that drug-induced liver injury was related to IRH caused by camrelizumab. Subsequently, we performed sequential dual-molecule plasma adsorption system (DPMAS) treatment with plasma exchange (PE). After two rounds of treatment, the patient's appetite significantly improved, the yellow color of urine reduced, and liver function improved (total bilirubin level decreased) after five rounds of treatment. Liver function normalized 4 wk after discharge. CONCLUSION: The use of sequential DPMAS with PE can reduce liver injury and systemic toxic reactions by clearing inflammatory mediators and harmful substances from blood, and regulate immune cell activity, which may be effective in the treatment of severe ICI-induced IRH. PMID:34141809 | PMC:PMC8173402 | DOI:10.12998/wjcc.v9.i17.4415 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Primary needle-knife fistulotomy for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: Importance of the endoscopist's expertise level

paythelady.612 shared this article with you from Inoreader Primary needle-knife fistulotomy for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: Importance of the endoscopist's expertise level Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 16;9(17):4166-4177. doi: 10.12998/wjcc.v9.i17.4166. ABSTRACT BACKGROUND: Needle-knife fistulotomy (NKF) is used as a rescue technique for difficult cannulation. However, the data are limited regarding the use of NKF for primary biliary cannulation, especially when performed by beginners. AIM: To assess the effectiveness and safety of primary NKF for biliary cannulation, and the role of the endoscopist's expertise level (beginner vs expert). METHODS: We retrospectively evaluated the records of 542 patients with naïve prominent bulging papilla and no history of pancreatitis, who underwent bile duct cannulation at a tertiary referral center. The patients were categorized according to the endoscopist's expertise level and the technique used for bile duct cannulation. We assessed the rates of successful cannulation and adverse events. RESULTS: The baseline characteristics did not differ between the experienced and less-experienced endoscopists. The incidence rate of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) was significantly affected by the endoscopist's expertise level in patients who received conventional cannulation with sphincterotomy (8.9% vs 3.4% for beginner vs expert, P = 0.039), but not in those who received NKF. In the multivariable analysis, a lower expertise level of the biliary endoscopist (P = 0.037) and longer total procedure time (P = 0.026) were significant risk factor of PEP in patients who received conventional cannulation with sphincterotomy but only total procedure time (P = 0.004) was significant risk factor of PEP in those who received NKF. CONCLUSION: Primary NKF was effective and safe in patients with prominent and bulging ampulla, even when performed by less-experienced endoscopist. We need to confirm which level of endoscopist's experience is needed for p rimary NKF through prospective randomized study. PMID:34141779 | PMC:PMC8173434 | DOI:10.12998/wjcc.v9.i17.4166 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anti-Yo antibody-positive paraneoplastic cerebellar degeneration in a patient with possible cholangiocarcinoma: A case report and review of the literature

paythelady.612 shared this article with you from Inoreader Anti-Yo antibody-positive paraneoplastic cerebellar degeneration in a patient with possible cholangiocarcinoma: A case report and review of the literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 16;9(17):4423-4432. doi: 10.12998/wjcc.v9.i17.4423. ABSTRACT BACKGROUND: Paraneoplastic cerebellar degeneration (PCD), which is rare in clinical practice, is closely related to autoimmunity. Cases positive for anti-Yo antibodies (anti-Purkinje cytoplasmic antibody 1) are the main subtype of PCD. PCD is subacute cerebellar degeneration, and while it progresses over weeks to months, its resultant deficits last much longer. Cancer patients with anti-Yo antibody-positive PCD are very rare. Most of them are breast cancer or ovarian cancer patients but also occasionally lung cancer patients. CASE SUMMARY: A 61-year-old woman presented with sudden vertigo, nausea, and vomiting for approximately 10 d. The patient's neurological examination showed torsion with downbeat nystagmus and ataxia of the right limb and trunk. Laboratory examination found that the patient's cerebrospinal fluid and serum were anti-Yo an tibody-positive, positron emission tomography computed tomography showed an increased metabolic rate in the retroperitoneal lymph nodes, and the pathology of lymph node punctures in the retroperitoneum and neck suggested adenocarcinoma of the pancreaticobiliary duct, which strengthens the hypothesis of paraneoplastic origin. Intravenous immunoglobulin (IVIg) 0.4 g/kg/d for 5 d and methylprednisolone 160 mg for 3 d were initiated, which was reduced to 80 mg for 3 d and then to 40 mg for 7 d. After treatment with IVIg and a steroid, the patient's vertigo and ataxia alleviated. CONCLUSION: The patient's vertigo and ataxia alleviated after treatment, suggesting that early immunotherapeutic intervention may have certain value in stopping neurological loss. PMID:34141810 | PMC:PMC8173421 | DOI:10.12998/wjcc.v9.i17.4423 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tunica vaginalis testis metastasis as the first clinical manifestation of pancreatic adenocarcinoma: A case report

paythelady.612 shared this article with you from Inoreader Tunica vaginalis testis metastasis as the first clinical manifestation of pancreatic adenocarcinoma: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 16;9(17):4244-4252. doi: 10.12998/wjcc.v9.i17.4244. ABSTRACT BACKGROUND: Metastases from pancreas or ampullary malignancies are common, but the spread to testicle and paratesticular tissue is exceedingly rare. To the best of our knowledge, fewer than 30 cases have been reported in the literature. More rarely, metastasis to tunica vaginalis testis occurs without involvement of the testes and epididymis. CASE SUMMARY: A 65-year-old male who complained of painless swelling of the left scrotum for over 1 wk was referred to the Department of Urology. Scrotal ultrasound showed left testicular hydrocele with paratesticular masses. Chest computed tomography revealed lung metastasis and enlarged left supraclavicular lymph node.The blood tumor markersalpha-fetoprotein, human chorionic gonadotropin, and serum lactate dehydrogenase were withinnormal limits.The preoperative diagnosis was left testicular tumor with lung metastasis. Then radical orchidectomy of the left testicle and high ligation of the spermatic cord were performed, and postoperative histopathology suggested metastatic tumors that was confirmed by an abdominal computed tomographic scan. The positive computed tomography findings, in conjunction with the expression of cytokeratin 7 (CK7), CK20, CK5/6, and absence of expression of Wilms' tumor suppressor gene 1, calretinin, melanocyte, prostate-specific antigen, thyroid transcription factor-1, GATA binding protein 3, caudal type homeobox 2, and napsinA supported the diagnosis of pancreatic adenocarcinoma. The outcome of this patient was unsatisfactory, and he died 3 mo later. CONCLUSION: This case suggests that pancreatic metastatic carcinoma must be considered in the differential diagnosis of scrotal enlargement. The advanced age of the patient wassuggestive of a secondary testicular tumor.In addition, careful physical examination and ultrasonography as well as radiologic al examination have become a standard modality. PMID:34141787 | PMC:PMC8173435 | DOI:10.12998/wjcc.v9.i17.4244 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intraneural ganglion cyst of the lumbosacral plexus mimicking L5 radiculopathy: A case report

paythelady.612 shared this article with you from Inoreader Intraneural ganglion cyst of the lumbosacral plexus mimicking L5 radiculopathy: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 16;9(17):4433-4440. doi: 10.12998/wjcc.v9.i17.4433. ABSTRACT BACKGROUND: Intraneural ganglion cysts are benign gelatinous masses that form within the epineurium of a peripheral nerve. Only few cases of intraneural ganglion cyst arising from the hip joint have been reported. CASE SUMMARY: A previously healthy 65-year-old woman who had been experiencing left buttock pain radiating to the dorsum of the foot for 2 years visited our clinic. Prior to visiting the clinic, she underwent lumbar spine magnetic resonance imaging and received physiotherapy, pain killers, and epidural injections based on a presumptive diagnosis of spinal stenosis for 2 years in other hospitals. Repeat magnetic resonance imaging revealed joint connection of the articular branch of the hip joint and rostral extension of the cyst along the L5 spinal nerve near the L5-S1 neural foramen. The patient was diagnosed with intraneural gangl ion cyst arising from the articular branch of the hip joint based on high-resolution magnetic resonance neurography. Using the arthroscopic approach, a cystic opening within the intra-articular space was detected, and cyst decompression was then performed. The pain in the left leg was significantly relieved during the 6-mo follow-up. CONCLUSION: Although intraneural ganglion cysts arising from the hip joint are rare, they can cause typical radicular pain and mimic common L5 radiculopathy. Typical cyst ascent phenomenon starting from the termination of the articular branch on magnetic resonance imaging is a crucial finding indicative of intraneural ganglion cysts arising from the hip joint. PMID:34141811 | PMC:PMC8173415 | DOI:10.12998/wjcc.v9.i17.4433 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Health-related quality of life after gastric cancer treatment in Brazil: Narrative review and reflections

paythelady.612 shared this article with you from Inoreader Health-related quality of life after gastric cancer treatment in Brazil: Narrative review and reflections Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 16;9(17):4123-4132. doi: 10.12998/wjcc.v9.i17.4123. ABSTRACT In Brazil, gastric cancer is the third most common type of cancer among men and fifth among women, with an estimated 13360 new cases among men and 7870 among women each year during the 2020-2022 period. This study presents reflections and attempts to add knowledge to the theme of quality of life (QoL) in patients with gastric adenocarcinoma and describes some of its characteristics in three regions of Brazil, with an evaluation of the disease's impacts in various dimensions of life, as reported by the patients themselves. We performed a narrative review of the literature and a data analysis of studies on QoL in Brazilian patients treated for gastric adenocarcinoma from three different cities in three geographic regions: Brasília (the midwest), Jaú (the southeast), and Macapá (the north). PMID:34141775 | PMC:PMC8173417 | DOI:10.12998/wjcc.v9.i17.4123 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effectiveness of patient education focusing on circadian pain rhythms: A case report and review of literature

paythelady.612 shared this article with you from Inoreader Effectiveness of patient education focusing on circadian pain rhythms: A case report and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 16;9(17):4441-4452. doi: 10.12998/wjcc.v9.i17.4441. ABSTRACT BACKGROUND: Neuropathic pain management should aim at improving quality of life and daily living activities of patients; therefore, emphasis should be placed on pain management including understanding the pain patterns during daily activity. Therefore, lifestyle guidance should be based on a detailed understanding of pain; however, previous studies commonly evaluated pain intensity at a single point in time. We report a case on patient education intervention based on the relationship between pain circadian rhythms and detailed physical activity during the day. CASE SUMMARY: A man in his 60s, who suffered a brachial plexus injury in a traffic accident, presented with neuropathic pain. Early assessment of the importance of daily living activities to the patient, pain rhythmicity, and physical activity, was performed. The early assessments show ed that the pain intensity was lower on days when more light-intensity physical activity (LIPA) was performed, than on days when less LIPA was performed. Consequently, patient education focused on methods to decrease the pain intensity that tended to worsen in the afternoon, and encouraged behavioral changes by suggesting the patient to take walks," which could be used to maintain LIPA in the afternoon. On reassessment, the afternoon LIPA, which had been the focus of attention, had increased and a change was noted in the circadian rhythm of pain. CONCLUSION: Patient education based on a composite assessment elicited positive results in relation to the pain circadian rhythm and physical activity. PMID:34141812< /a> | PMC:PMC8173436 | DOI:10.12998/wjcc.v9.i17.4441 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Liver injury associated with the use of selective androgen receptor modulators and post-cycle therapy: Two case reports and literature review

paythelady.612 shared this article with you from Inoreader Liver injury associated with the use of selective androgen receptor modulators and post-cycle therapy: Two case reports and literature review Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jun 6;9(16):4062-4071. doi: 10.12998/wjcc.v9.i16.4062. ABSTRACT BACKGROUND: Muscle growth promoters are being developed for the treatment of disease-induced loss of muscle mass. Ligandrol and ostarine are selective androgen receptor modulators (SARMs) with a non-steroidal structure and a presumably more favorable side effect profile. In recent years, these substances with or without "post-cycle therapy" (PCT) are often misused by amateur athletes aiming to promote muscle growth. At the same time, reports on their toxic effects on organ systems are emerging. CASE SUMMARY: We report two cases of liver injury in young men who used ligandrol and/or ostarine for a few weeks followed by the use of substances for PCT. Acute liver injury occurred in both cases after stopping SARMs while on PCT. The clinical picture was dominated by jaundice and fatigue. The biochemical pattern showed a mixed type of injury with n ormal alkaline phosphatase and high concentrations of bilirubin and serum bile acids. Histological evidence showed predominantly cholestatic injury with canalicular bile plugs, ductopenia, and mild hepatocellular damage without significant fibrosis. The patients recovered from the condition after 3 mo. The off target effects of SARMs were likely idiosyncratic, but our report highlights the yet unrecognized effects of other toxic substances used for PCT, supra-therapeutic doses, and the complete absence of monitoring for adverse effects. CONCLUSION: Among muscle-building amateur athletes, SARMs (ligandrol or ostarine) and/or substances in PCT may cause cholestatic liver injury with prolonged recovery. PMID:3414 1767 | PMC:PMC8180234 | DOI:10.12998/wjcc.v9.i16.4062 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.